With the 2016 presidential election just days away, debates on the personalities, as well as the policy agendas, of the respective candidates have become increasingly fierce. Donald Trump and Hillary Clinton may both be moderates at heart, but their official policy platforms represent near-extremes of the political spectrum. This holds especially true in their proposals regarding health care: Trump’s proposal, entitled “Health Care Reform to Make America Great Again,” and Clinton’s, “Universal, Quality, Affordable Health Care for Everyone in America,” together paint a picture of the spectrum of opinions and debates surrounding health care.
|Title of Plan||Health Care Reform to Make America Great Again||Universal, Quality, Affordable Health Care for Everyone in America|
|Affordable Care Act||Repeal immediately||Strengthen and expand|
|Public Insurance Option||Opposes||Supports|
|Health for Undocumented Immigrants||Opposes||Supports|
|Access to Reproductive Health Care||Reduce access to abortion, contraception, and preventative care||Defend|
|Plan to Reduce Prescription Drug Prices||Allow foreign manufacturers in U.S. markets||Same as current, plus separate ~ 9 point plan|
Overview: From the outset, Clinton and Trump’s plans portray drastically different pictures of the current state of health care in America, as each is written in a tone that reflects the candidate’s approach to their respective campaigns.
Trump: Mr. Trump places the blame of our health care troubles with the Obama administration and Democrats’ pursuit of health care reform, which ultimately resulted in the Patient Protection and Affordable Care Act of 2010, also known as the ACA or “Obamacare.” He characterizes the ACA as a “terrible,” “damaging,” “economic burden” which is “sure to crumble.” Though his plan is not particularly detailed outside of criticizing regulation, public health care spending, and the ACA in broad terms, he promises that his proposed reforms will help “make America great again.”
Clinton: Secretary Clinton’s argues that although great progress has been made in health care over the past few decades, there is still a great amount of work standing between our current state and affordable access for all. The outset of Clinton’s proposal states that she has “led and will continue to lead the fight to expand health care access for every American.” The plan details how to expand efforts started under President Obama, placing affordable care as a top priority.
Affordable Care Act:
Overview: Throughout the Obama presidency, supporters and opponents alike have hotly contested the implementation of the ACA. The arguments have closely followed party lines, and this continues to ring true in the respective health care proposals of both presidential candidates.
Trump: Mr. Trump promises to completely repeal the ACA on day one of his presidency. He proposes a shift to “free market” health reform, as he believes that the American people should only buy health insurance if they want, and that the price of insurance should be determined purely by market forces. His plan would allow competition between insurance companies across state lines, which was not achieved under the ACA even though it was initially proposed.
Clinton: Secretary Clinton vows to defend and expand the ACA, including the creation of a public option. The Atlantic has dubbed her healthcare plan as “Obamacare Plus,” which seems appropriate given that she intends to expand and mend parts of the ACA that remain problematic. Her proposed changes to the ACA include: (1) tax credit up to $2,500 for individuals whose out-of-pocket medical spending exceeds 5 percent of their income, and (2) lowering the maximum payment individuals making less than $47,000 per year face when purchasing insurance on the exchanges. Additionally, she proposes providing individuals over the age of 55 the option of buying into Medicare.
Medicaid Question and Coverage for Undocumented Persons:
Overview: The growing demand of Medicaid has been a political and economic concern since before President Obama took office, and it has only grown in importance since the ACA put it in the spotlight. In 2014, there was an 11 percent increase in spending for Medicaid. As of 2016, 19 states still had not expanded Medicaid to their state health programs as offered under the ACA.
Trump: Mr. Trump hopes to reduce the number of Medicaid beneficiaries and argues that enforcing current immigration laws could and should be a major way to cut health care costs. According to his plan, “providing health care to illegal immigrants costs us some $11 billion annually.” He therefore proposes “restricting the unbridled granting of visas to this country.” Furthermore, Mr. Trump plans to block-grant Medicaid to states, to “do away with any federal overhead.” This would allow states to receive their Medicaid funding as a lump-sum from the federal government to spend and allocate as they wish.
Clinton: Secretary Clinton supports the continued expansion of Medicaid, and has even stipulated that access should be granted to families regardless of immigration status. This would allow an often unprotected and disempowered group to purchase insurance on the health exchange.
Overview: Perhaps the most developed policies in their respective plans are the candidates’ approaches to rising pharmaceutical drug costs. Both candidates place some responsibility for growth of medical spending on the cost of both generic and name-brand prescription medication, but propose different approaches to tackling the issue.
Trump: Mr. Trump hopes to include international drug manufacturers in his free-market proposal for health care in order to create more competition in this market. He states: “Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service.”
Clinton: Secretary Clinton has released an additional multi-part proposal dedicated solely to lowering the costs of prescription drugs. In the plan, she proposes denying tax breaks for direct-to-consumer advertising with an FDA pre-approval process for such ads, a policy supported by the American Medical Association (AMA). Clinton also points to programs in Maine and California that place a $250/month limit on out-of-pocket prescription drug costs as a possible model to introduce national caps on out-of-pocket spending for patients. Furthermore, she proposes importing drugs from other countries, with the caveat that it must be through a safe and secure process and limited to only personal use.
Trump’s Additional Suggestions:
Mr. Trump has included some other unique ideas in his plans to Congress. Importantly, his plan includes proposals to (1) improve disparities in access to mental health care, and (2) allow tax deductions for health insurance premium payments. He also supports the use of “Health Savings Accounts,” tax-free accounts intended to supplement high-deductible plans, which he argues would be particularly well-suited for younger persons in good health. He states that these accounts “become part of the estate of the individual and could be passed on to heirs.” These policies, though, are truly only viable for higher-income individuals with access to the funds needed to meet a high deductible in an emergency situation. Finally, his plan emphasizes restricting women’s right to terminate an unwanted pregnancy, a difference between the candidates that took center stage in the final presidential debate.
Clinton’s Additional Suggestions:
Secretary Clinton has included wide-reaching discussions on the state of health care for rural Americans, reproductive rights, the National Health Services Corps and community health centers. For Americans living in a rural setting, Clinton suggests expanding access through a novel telehealth model and establishing appropriate methods of reimbursement for this practice. Clinton has also come forward with a very strong statement in support of reproductive rights. Finally, she agrees to continue Obama’s call for tripling the size of the National Health Service Corps.
As can be expected from the controversial presidential race thus far, both candidates have revealed strongly opposing views on most key issues included in their respective health care plans. Several of these issues, such as immigration reform and the Affordable Care Act, were mainstays of their respective party platforms, and have evolved throughout the primary season. Others became part of the party dialogue throughout the primary process, where candidates including Senators Sanders, Rubio and Cruz fought hard to integrate their stances into the mainstream. Of course, virtually none of the proposed policies mentioned could be made unilaterally by the executive branch; rather, they would have to be passed as legislation through Congress. At this point, the best way to help push policy in either direction is to use our right and go vote by November 8th.
Editor’s note: This piece was originally written for the Latino Medical Student Association Policy Summit Newsletter in Washington, DC (10/21-10/23), and has since been readapted. All quotes are from the respective candidate’s website unless otherwise indicated.